Staffing guidelines without central monitoring

[babynurse357]

I've looked on AWHONN's site and can't find any recommendation about staffing when you don't have central monitoring. I've been a labor nurse for 6 years and I've always worked in a facility with central monitoring and the place I am working at now doesn't have it. We deliver about 20 babies a month give or a take a few. A few labor nurses (myself included) are concerned about the safety of having 2 pts on continuous EFM without central monitoring. Most of our pts end up with pitocin during their labor either for induction or augmentation. Then there are a few nurses who think it's no big deal to have 2 inductions at the same time. I've done 2 labors at once but never without central monitoring. Can anyone shed some light on this? Is the AWHONN guideline the same regardless of whether or not central monitoring is available? Pitocin is a high risk drug and 2 inductions per nurse without central monitoring seems very unsafe. Thanks!

[Peetz, BSN]

I agree, it seems dangerous to have two pt's being induced at the same time without a remote monitor for one person to keep an eye on. Could you approach the hospital board with the evidence based practice that says it is safer and more convenient, and may be a money saver in the long run. ( a safer L & D brings in more clients) It may be a system they are willing to look into purchasing for their hospital. If not and you are the one in charge of staffing, hire a nurse to watch each one, or at least be free ( possibly from another department to pull from) to respond to it when needed.

[babynurse357]

Approaching the board is out of the question because our OB/GYN is the head of the board. It's a new physician owned facility and he hates central monitoring. He wants the nurses at the bedside and says with central monitoring nurses spend too much time at the desk. It's expensive I know but cheaper than a lawsuit in my opinion.

[babyktchr, BSN, RN]

Well....for YEARS I worked without central monitoring and we held to AWHONN standards. We kept monitors up very loud and honestly you could be in the middle of something and hear a decel down the hall. Ever since central montoring has come to be...we sit and wonder what we ever did without it. If we have downtime (our central system goes down for one reason or another) we automatically go to 1:1 care of laboring patients. I do not think there is any guideline or standard written by AWHONN to support it but I would bet that your risk department may have something to say. While your chief of OB/board member has a valid point (lets face it, how many of us chart outside of the room instead of at the bedside) there are other "pros" to having a centralized monitoring system. Certainly there could be endless challenges to this doctor from a risk point of view that could sway him. I will have to do a lit search and see if there is any evidenced based guidelines on central monitoring or if it has become standard of care or not. Interesting question. I would really go and speak with your risk department director and see what they have to say.

[babynurse357]

Well as of right now we do staff 1:1 with our labor pts. It was just that somebody brought up staffing guidelines the other day and I'm a little concerned that when we do start having more babies he'll hold us to to 1:2 without central monitoring.

[SmilingBluEyes]

I would discuss the situation with the risk mgt department of your hospital, and really, really push for central monitoring to be put on the budget ASAP. I cannot see how it's safe to monitor 2 laboring patients (who require continuous monitoring) without central monitoring capability!